Dietary supplements are a $40 billion-a-year industry. But are supplements all that necessary? Is it smart to take them?
Could it be that you’re literally peeing your hard-earned money down the toilet?
Worse, could you be doing more harm than good?
Some medical professionals and nutritionists argue that dietary supplements are necessary because:
- Most people don't eat enough fruits and vegetables.
- Most people eat processed foods, which lack essential nutrients.
- The soil in which our food is grown is depleted, thus lacking essential minerals.
- Pregnant women and the elderly need more vitamins than food provides.
- The consumption of pharmaceuticals may interfere with vitamin absorption.
But look more closely and you can find horror stories about many supplements on the market. An analysis by the Food and Drug Administration (FDA) found that 776 dietary supplements sold over the counter between 2007 and 2016 contained unapproved ingredients. "These products have the potential to cause severe adverse health effects owing to accidental misuse, overuse, or interaction with other medications, underlying health conditions, or other drugs within the same dietary supplement," wrote the authors of the study, published in JAMA Open Network.
In 2017, a study published in the Journal of Clinical Oncology found that taking vitamin B6 and B12 supplements in high doses seems to triple some people’s risk of lung cancer. Concerns within the medical community about cancer and B vitamins, which are some of the most commonly taken supplements, have been brewing for a few decades, The Atlantic reports.
Poison control centers in the U.S. receive a call every 24 minutes regarding an adverse exposure to a dietary supplement, according to a July 2017 report in the Journal of Medical Toxicology. The study reported a 49 percent increase in calls from 2005 to 2012. Some 70 percent of those calls were about children, most of whom had been exposed to the supplements accidentally.
The effects of some of these supplements can be serious, too. Yohimbe, a supplement made from an evergreen tree in western Africa, is touted as a treatment for impotence, erectile dysfunction, weight loss, high blood pressure and many other ills, according to the National Center for Complementary and Integrative Health. But the study found that exposure to yohimbe resulted in the largest proportion of serious outcomes among the more than 2750,000 calls to poison centers that the researchers tracked. Yohimbe can cause changes in heartbeat rhythm, kidney failure, seizures, heart attack and death.
Curious if a supplement is good for you? The NIH fact sheet breaks it down for you. (Photo: National Institutes of Health)
The FDA points out that "millions of Americans responsibly consume multi-vitamins and experience no ill effects." However, dietary supplements are not regulated in the same way medications are because they're categorized as food under the 1994 Dietary Supplement Health and Education Act, which means the FDA considers them safe until proven unsafe. But supplements do have their own set of regulations that are different from "conventional" foods. The FDA cautions that "many supplements contain ingredients that have strong biological effects, and such products may not be safe in all people. If you have certain health conditions and take these products, you may be putting yourself at risk."
FDA Commissioner Scott Gottlieb announced in February 2019 that the agency is stepping up its efforts on regulating dietary supplements. The FDA is developing a rapid-response tool to alert consumers about products that contain an ingredient that's either illegal or potentially dangerous. At the same time, they would alert companies to stop manufacturing and selling the products.
In addition to the rapid-response tool, the FDA also created the Botanical Safety Consortium to evaluate the safety and effectiveness of botanical ingredients and mixtures in dietary supplements.
To help determine whether or not you should take a supplement, the National Institutes of Health created a fact sheet that lists the most common supplement ingredients, how they work, and whether or not they are safe.
Other studies have given weight to the FDA's words of caution. A Consumer Reports story outlined a tragic case from 2014. A baby was born two months premature and given a probiotic in the NICU to prevent an intestinal infection. However, the probiotic caused a severe fungal infection in his intestines instead, and the baby died at eight days old. The FDA investigated and found the probiotic was contaminated with the fungus, which led to a massive nationwide recall and a statement from the FDA urging doctors to exercise more caution when using supplements in people with compromised immune systems.
Another peer-reviewed study from 2009 was penned by several researchers at the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center in Seattle. After following up with more than 160,000 post-menopausal women during the 1990s, for an average of eight years, the researchers’ study “provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD (cardiovascular disease), or total mortality in postmenopausal women.”
Debunking supplements doesn’t stop there. Experts at the National Institutes of Health argued in 2006 that there’s no clear evidence that vitamins prevent chronic diseases.
So what have researchers concluded from supplements?
- Health benefits of taking multivitamins is still up for debate.
- Some people may be getting too much of certain nutrients.
- There may be possible interactions between multivitamins and minerals and prescribed or over-the-counter medications.
In addition, some supplements may not even contain the ingredients shown on the label. In September 2016, New York's attorney general cracked down on NBTY, which sells popular supplement brands including Solgar and Nature Bounty, reports USA Today. Per an agreement, the company will conduct more stringent testing to make sure the products actually contain the herbs promised on the label. Past reports had shown that the supplements often contained fillers such as powdered rice, instead of the herbs pictured. NBTY sells ginseng, ginkgo biloba and nearly 22,000 other products.
What about antioxidant pills?
Marketing gurus have helped companies make millions by touting the latest antioxidant product du jour, be it the acai berry, mangosteen, blueberry, Omega 3s…the list goes on.
But research published in the Journal of the American Medical Association says not only can some antioxidant supplements be ineffective, they can be hazardous to your health. The 2007 study of more than 232,000 people concluded that antioxidant supplements can "increase the risk of death."
Gulp. Talk about a bitter pill to swallow. Why would antioxidants be bad for you? Researchers theorize that we shouldn’t be as vigilant about free radicals as we are; our body actually needs some amount of them to perform certain functions like regulating blood sugar levels.
Confused? Talk to your doctor
If you’re pregnant, your doctor may advise you to take supplemental folate. Susceptible to cold sores? You may need supplemental lysine, an amino acid. Concerned about prostate health? Saw palmetto or a bevy of other natural supplements might be the right choice. Digest food poorly? Hydrochloric acid and pepsin might be beneficial. Taken antibiotics lately? Consider recolonizing your digestive tract with probiotics. Most of your immune system lies within your gut, so if you’re going to choose one supplement to take, consider one that aids digestive health. If you eat a poor diet, a multivitamin split in half and taken in the morning and evening might be effective.
The key? Before you take anything — anything — talk to your healthcare professional.
Editor's note: This story has been updated since it was originally published in September 2011.